Individual
MR. DALE E MORTENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1101 OHIO AVE, LYNN HAVEN, FL 32444-2554
(850) 265-6163
(850) 265-4059
Mailing address
POB 1960, LYNN HAVEN, FL 32444-6960
(850) 265-6163
(850) 265-4059
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH4624
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
70497
BCBS
FL
Enumeration date
11/13/2006
Last updated
03/18/2015
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